Inflammatory bowel disease (IBD) is a condition causing inflammation of the digestive tract. The two main forms of IBD are Crohn’s disease (CD) and ulcerative colitis (UC). One of the common symptoms experienced by patients with IBD is anemia. For people with IBD who have been diagnosed with anemia, and are experiencing some anemia-related symptoms, iron supplementation can be an important part of symptom management.
What is anemia?
Anemia is a condition in which a patient’s blood does not carry enough oxygen throughout the body.1 The most common cause of anemia is not having enough iron in the body. However, it can also be caused by a lack of vitamin B12 or folate.
Anemia is a very common among people with inflammatory bowel diseases such as CD and UC. It is the most common complication occurring outside of the digestive tract, experienced by around one-third of patients with IBD. For patients diagnosed with anemia due to iron deficiency, healthcare provider will often recommend that they take an iron supplement.1
How is anemia treated with iron supplementation?
Patients diagnosed with anemia caused by IBD can often benefit from taking iron supplements.1 The goal of iron supplementation is to reduce the symptoms associated with iron-deficiency anemia and improve the patient’s overall quality of life. Patients with anemia due to IBD will work with their healthcare provider to decide upon the best option for treatment. There are two forms of iron supplementation:
Oral iron supplementation
Intravenous iron therapy
What is oral iron supplementation?
Oral iron supplementation involves taking iron via tablet or capsule by mouth. For patients with mild anemia or IBD that is not currently active, oral iron supplementation is often considered a good option. A healthcare provider will monitor the patient’s response to the iron supplement to make sure that enough of the iron in the supplement is being absorbed.1
However, for some patients, oral iron supplementation does not work well enough to treat the anemia. Studies have suggested that more than 90% of iron delivered in an oral supplement can remain unabsorbed. This can lead to some adverse side effects such as nausea, flatulence, diarrhea or constipation, and inflammation in the stomach lining.1
What is intravenous iron therapy?
Intravenous (IV) iron therapy may be recommended for patients who cannot tolerate oral iron supplementation, or who experience adverse side effects. IV iron therapy is prescribed and administered by a patient’s healthcare provider. While there are currently 6 types of IV Iron preparations that are generally considered to be safe, some gastroenterologists are still reluctant to administer iron intravenously. Patients receiving IV iron supplementation are closely monitored to make sure that they do not have any adverse reactions or side effects.1
Are there any alternative procedures to treat iron-deficiency anemia?
In some cases, where neither oral iron therapy nor IV iron therapy are successful in treating a patient with iron-deficiency anemia, a blood transfusion may be recommended. Red blood cell (RBC) transfusions have been used to successfully treat anemia and may be a good option for patients who have not responded well enough to other forms of treatment. However, RBC transfusions do present some health risks and can be an expensive option. This procedure is typically restricted to patients experiencing acute severe anemia.1
Written by: Anna Nicholson and Emily Downward | Last Reviewed: May 2019.
Stein J, Dignass AU. Management of iron deficiency anemia in inflammatory bowel disease – a practical approach. Annals of Gastroenterology 2013;26:104-113.